The BRISK-ED pilot randomised controlled trial compared the use of balanced crystalloids (Ringer’s lactate) versus normal saline in managing adult patients with diabetic ketoacidosis in the emergency department. Conducted at London Health Sciences Centre in Ontario, Canada, the study aimed to assess the feasibility of a future full-scale trial. Despite being conducted during the COVID-19 pandemic, the trial successfully enrolled patients and exceeded the minimum target recruitment rate without breaking blinding or loss to follow-up. The study highlighted considerations for future trial designs, such as the potential for cluster randomisation and the importance of robust prescreening. The pilot study was not powered to determine clinical differences between groups, and a larger sample size would be needed for definitive results.

The BRISK-ED pilot randomised controlled trial compared the efficacy of balanced crystalloids (Ringer’s lactate) versus normal saline in treating adults with diabetic ketoacidosis (DKA) in the emergency department. Conducted at London Health Sciences Centre in Ontario, Canada, the study aimed to assess the feasibility of a larger trial. The trial successfully enrolled patients, maintained blinding, and had no loss to follow-up. The study highlighted the need for robust prescreening and suggested that future trials might benefit from a cluster randomisation design. The results indicated that balanced crystalloids might lead to faster DKA resolution, but a larger sample size is needed for definitive conclusions.